Pelvic organ prolapse: What is it and why did it happen to me?

You have gone to your annual gynecology exam and your doctor has just told you that your bladder has "fallen".  Even with the explanation given to you at your visit, you are still confused as to what exactly has happened to your bladder and how it is affecting your bladder function.  Let's start with a brief overview of pelvic organ prolapse and what it means to your health.

Pelvic organ prolapse (POP) occurs when you lose support for three pelvic organs - the bladder, the uterus and/or the rectum - which causes them to sag, or herniate, into your vagina.  You can also lose support at the top of the vagina after a hysterectomy which causes the vagina to collapse on itself, similar to what happens when you pull the lining of a pocket inside out.  This sagging, or herniation, can go completely unnoticed and only brought to your attention at your annual exam or it can cause significant discomfort and pressure as the vaginal walls get closer to, or actually come out of, the vaginal opening.

The most common causes of POP are a history of vaginal delivery or hysterectomy.  All women experience some pelvic floor nerve and muscle damage after vaginal delivery.  While most recover normal function within the next six months, a few women will experience prolapse, including uterine prolapse that causes the cervix to protrude from the vagina.  Hysterectomy involves the cutting of supporting ligaments to remove the uterus and, with time, those ligaments can stretch and weaken enough that they no longer support the top of the vagina and allow it to sag toward the vaginal opening.

POP incidence also increases with the natural weakening of vaginal tissue with age, particularly after menopause.  Estrogen, which is important to the production of the supportive tissue collagen, experiences a dramatic decrease in production after menopause which, in turn, increases the risk for prolapse.  You are also at higher risk for prolapse with a family history of other relatives who have experienced prolapse, particularly your mother.

It is important to keep in mind that you did not "cause" your prolapse.  Prolapse occurrence is related to a variety of factors, many of which are beyond your control.  The good news is that we currently have a variety of tools to manage prolapse effectively and I will cover those over the next few weeks.